Rekonstruktion des Lig.patellofemorale mediale bei patellofemoraler Instabilität

Zusammenfassung: Obwohl Instabilitäten und mechanische Fehlbelastung im patellofemoralen Gelenk sehr häufig auftreten, besteht immer noch ein ungenügendes Verständnis der Interaktionen zwischen den einzelnen mechanischen Faktoren, die die Kinematik und Stabilität des Patellofemoralgelenks beeinflussen. Die patellofemorale Stabilität wird von passiven und aktiven Faktoren beeinflusst: Der Geometrie des patellofemoralen Gelenks und den medialen und lateralen Weichteilkräften wie z.B. dem Lig.patellofemorale mediale (LPFM, passive Stabilisatoren) sowie den Muskelkräften des Streckapparats (aktive Stabilisatoren). Neben den knöchernen Strukturen sind die medialen passiven Stabilisatoren wesentlich für die patellofemorale Stabilität verantwortlich. Die Verletzung des LPFM stellt die essenzielle Verletzung im patellofemoralen Gelenk dar, ohne die eine Luxation der Patella nahezu unmöglich ist und die in ca. 90% aller erstmaligen Patellaluxationen auftritt. Da klinisch und biomechanisch gezeigt werden konnte, dass die Rekonstruktion des LPFM eine höhere Stabilität erreicht als die bisher vornehmlich durchgeführten konventionellen Eingriffe am Streckapparat, ohne gleichzeitig ein Schmerzsyndrom zu verursachen, gilt dieser Eingriff heute als Mittel der Wahl zur Patellastabilisierun

CT changes after trochleoplasty for symptomatic trochlear dysplasia

Trochlear dysplasia is an important risk factor for patellar instability. Because of a decreased trochlear depth in combination with a low lateral femoral condyle, the patella cannot engage properly in the trochlea. Trochleoplasty is a surgical procedure, which strives to correct such bony abnormalities. The aim of this study was to describe morphological features of trochlear dysplasia and the corrective changes after trochleoplasty on CT scan. The study group consists of 17 knees with trochlear dysplasia having undergone trochleoplasty for recurrent patellofemoral dislocation at a mean age of 22.4years. The evaluation consisted in pre- and postoperative measurements on the proximal and distal trochlea on transverse CT scans in order to determine the morphological features. We measured the transverse position and depth of the trochlear groove, the transverse position of the patella, the ratio between the posterior patellar edge and the trochlear groove, the lateral patellar inclination angle, the sulcus angle, and the lateral trochlear slope. The trochlear groove lateralised a mean of 6.1mm in the proximal aspect and 2.5mm in the distal aspect of the trochlea, while the patella medialised a mean of 5mm. Preoperatively the patella was lateral in relation to the trochlear groove in 13 cases, neutral in two cases, and medial in two cases. Postoperatively it was lateral in four cases, in neutral position in seven cases, and medialised in six cases, referenced to the trochlear groove. The trochlear depth increased from 0 to 5.9mm postoperatively in the proximal aspect of the trochlea, and from 5.5 to 8.3mm postoperatively in the distal trochlea. The lateral patellar inclination angle decreased from a mean of 21.9° to a mean of 7.8°. The sulcus angle decreased from a mean of 172.1° to a mean of 133° in the proximal trochlea and from a mean of 141.9° to a mean of 121.7° in the distal trochlea. The lateral trochlear slope changed from 2.8° to 22.7° in the proximal and from 14.9° to 26.9° in the distal part of the trochlea. In the CT scan patients with trochlear dysplasia demonstrated a poor depth, or even a flat or convex trochlea with a greater sulcus and lateral trochlear slope angle, a lateralised patella to the trochlear groove with poor congruency, and a greater lateral patellar inclination angle. Trochleoplasty can correct the pathological features of trochlear dysplasia by surgically creating more normal anatomy. The goal of this surgical procedure is to steepen and lateralise the trochlear groove for a better engagement of the patell

The role of side information in steganography

Das Ziel digitaler Steganographie ist es, eine geheime Kommunikation in digitalen Medien zu verstecken. Der übliche Ansatz ist es, die Nachricht in einem empirischen Trägermedium zu verstecken. In dieser Arbeit definieren wir den Begriff der Steganographischen Seiteninformation (SSI). Diese Definition umfasst alle wichtigen Eigenschaften von SSI. Wir begründen die Definition informationstheoretisch und erklären den Einsatz von SSI. Alle neueren steganographischen Algorithmen nutzen SSI um die Nachricht einzubetten. Wir entwickeln einen Angriff auf adaptive Steganographie und zeigen anhand von weit verbreiteten SSI-Varianten, dass unser Angriff funktioniert. Wir folgern, dass adaptive Steganographie spieltheoretisch beschrieben werden muss. Wir entwickeln ein spieltheoretisches Modell für solch ein System und berechnen die spieltheoretisch optimalen Strategien. Wir schlussfolgern, dass ein Steganograph diesen Strategien folgen sollte. Zudem entwickeln wir eine neue spieltheoretisch optimale Strategie zur Einbettung, die sogenannten Ausgleichseinbettungsstrategien.The  goal of digital steganography is to hide a secret communication in digital media. The common approach in steganography is to hide the secret messages in empirical cover objects. We are the first to define Steganographic Side Information (SSI). Our definition of SSI captures all relevant properties of SSI. We explain the common usage of SSI. All recent steganographic schemes use SSI to identify suitable areas fot the embedding change. We develop a targeted attack on four widely used variants of SSI, and show that our attack detects them almost perfectly. We argue that the steganographic competition must be framed with means of game theory. We present a game-theoretical framework that captures all relevant properties of such a steganographic system. We instantiate the framework with five different models and solve each of these models for game-theoretically optimal strategies. Inspired by our solutions, we give a new paradigm for secure adaptive steganography, the so-called equalizer embedding strategies

The trochlear isometric point is different in patients with recurrent patellar instability compared to controls: a radiographical study

Purpose: The purpose of the study was to investigate the theoretical isometric point based of the curve of the femoral groove and relating it to the origin of the MPFL femoral tunnel on lateral radiograph by comparing a patellar instability cohort with a control cohort. Methods: From a Patellar Instability database the radiographs of 40 consecutive patients were analysed to define Schöttle’s point, and the arc of the circle of the trochlear groove. A comparison population of 20 radiographs from comparable patients with tibiofemoral joint disorders was used as a control. The distance from Schöttle’s point to the most anterior part of the groove (extension) was also compared to the distance to the distal end of the roof of the notch (flexion). Results: The trochlea was circular in the controls but not the Patellofemoral Instability cohort where trochlear dysplasia is usually present. The difference between the extension and flexion length was a mean of − 2.0 ± 0.5 mm in the controls and + 6.0 ± 0.5 mm in the patellofemoral cohort. In neither cohort did the centre of the circle correspond to Schöttle’s point. The extension distance correlated with the boss height. Conclusions: The dysplastic trochlea is not circular and the centre of the best matched circle was different to the control trochleae which were circular. The circle centres did not correlate with Schöttle’s point for either cohort, and was more proximal in the Patellofemoral Instability cohort. Clinical relevance: For the MPFL to have equal tension throughout flexion within the groove, the length should not change. In normal knees the MPFL does not behave isometrically. The change in length, as measured from Schöttle’s point to the trochlea, was greater for patellofemoral instability patients explaining why an isolated MPFL reconstruction in the presence of severe trochlear dysplasia risks poor outcomes

Disturbed Processing of Contextual Information in HCN3 Channel Deficient Mice

Hyperpolarization-activated cyclic nucleotide-gated channels (HCNs) in the nervous system are implicated in a variety of neuronal functions including learning and memory, regulation of vigilance states and pain. Dysfunctions or genetic loss of these channels have been shown to cause human diseases such as epilepsy, depression, schizophrenia, and Parkinson's disease. The physiological functions of HCN1 and HCN2 channels in the nervous system have been analyzed using genetic knockout mouse models. By contrast, there are no such genetic studies for HCN3 channels so far. Here, we use a HCN3-deficient (HCN3(-/-)) mouse line, which has been previously generated in our group to examine the expression and function of this channel in the CNS. Specifically, we investigate the role of HCN3 channels for the regulation of circadian rhythmand for the determination of behavior. Contrary to previous suggestions we find that HCN3(-/-) mice show normal visual, photic, and non-photic circadian function. In addition, HCN3(-/-) mice are impaired in processing contextual information, which is characterized by attenuated long-term extinction of contextual fear and increased fear to a neutral context upon repeated exposure

Origin and insertion of the medial patellofemoral ligament: a systematic review of anatomy.

PURPOSE: The medial patellofemoral ligament (MPFL) is the major medial soft-tissue stabiliser of the patella, originating from the medial femoral condyle and inserting onto the medial patella. The exact position reported in the literature varies. Understanding the true anatomical origin and insertion of the MPFL is critical to successful reconstruction. The purpose of this systematic review was to determine these locations. METHODS: A systematic search of published (AMED, CINAHL, MEDLINE, EMBASE, PubMed and Cochrane Library) and unpublished literature databases was conducted from their inception to the 3 February 2016. All papers investigating the anatomy of the MPFL were eligible. Methodological quality was assessed using a modified CASP tool. A narrative analysis approach was adopted to synthesise the findings. RESULTS: After screening and review of 2045 papers, a total of 67 studies investigating the relevant anatomy were included. From this, the origin appears to be from an area rather than (as previously reported) a single point on the medial femoral condyle. The weighted average length was 56 mm with an 'hourglass' shape, fanning out at both ligament ends. CONCLUSION: The MPFL is an hourglass-shaped structure running from a triangular space between the adductor tubercle, medial femoral epicondyle and gastrocnemius tubercle and inserts onto the superomedial aspect of the patella. Awareness of anatomy is critical for assessment, anatomical repair and successful surgical patellar stabilisation. LEVEL OF EVIDENCE: Systematic review of anatomical dissections and imaging studies, Level IV

Stronger Neural Modulation by Visual Motion Intensity in Autism Spectrum Disorders

Theories of autism spectrum disorders (ASD) have focused on altered perceptual integration of sensory features as a possible core deficit. Yet, there is little understanding of the neuronal processing of elementary sensory features in ASD. For typically developed individuals, we previously established a direct link between frequency-specific neural activity and the intensity of a specific sensory feature: Gamma-band activity in the visual cortex increased approximately linearly with the strength of visual motion. Using magnetoencephalography (MEG), we investigated whether in individuals with ASD neural activity reflect the coherence, and thus intensity, of visual motion in a similar fashion. Thirteen adult participants with ASD and 14 control participants performed a motion direction discrimination task with increasing levels of motion coherence. A polynomial regression analysis revealed that gamma-band power increased significantly stronger with motion coherence in ASD compared to controls, suggesting excessive visual activation with increasing stimulus intensity originating from motion-responsive visual areas V3, V6 and hMT/V5. Enhanced neural responses with increasing stimulus intensity suggest an enhanced response gain in ASD. Response gain is controlled by excitatory-inhibitory interactions, which also drive high-frequency oscillations in the gamma-band. Thus, our data suggest that a disturbed excitatoryinhibitory balance underlies enhanced neural responses to coherent motion in ASD

Respiratory vasculatures of the intertidal air-breathing eel goby, Odontamblyopus lacepedii (Gobiidae: Amblyopinae)

Lacking a propensity to emerge over the mud surface, the eel goby, Odontamblyopus lacepedii, survives low tide periods by continuously breathing air in burrows filled with hypoxic water. As with most marine air-breathing fishes, O. lacepedii does not possess an accessory air-breathing organ, but holds air in the buccal-opercular cavity. The present study aimed to clarify how the respiratory vasculature has been modified in this facultative air-breathing fish. Results showed that the gills apparently lacked structural modifications for air breathing, whereas the inner epithelia of the opercula were richly vascularized. Comparison with two sympatric gobies revealed that the density of blood capillaries within 10μm from the inner opercular epithelial surface in O. lacepedii (14.5 ± 3.0 capillaries mm-1; mean ± s.d., n = 3) was significantly higher than in the aquatic non-air-breathing Acanthogobius hasta (0.0 ± 0.0) but significantly lower than in the amphibious air-breathing mudskipper, Periophthalmus modestus (59.1 ± 8.5). The opercular capillary bed was supplied predominantly by the 1st efferent branchial arteries (EBA1) and drained by the opercular veins, which open into the anterior cardinal vein. Deep invaginations at the distal end of the EBA1 and the junction with EBA2 are suggestive of blood flow regulatory sites during breath-holding and apnoeic periods. It remains to be investigated how blood flow through the gills is maintained during breath holding when the buccal-opercular cavity is filled with air